Dr Kumar Also known as Dr Kumar & Dr Sinha Shoebury Health Centre

Updated 6 July 2016

Dr Kumar is located in a purpose built medical centre in a predominantly residential area of Shoeburyness, Southend in Essex. The practice provides services for 6901patients.

The practice holds a General Medical Services (GMS) contract and provides GP services commissioned by NHS England and Southend Clinical Commissioning Group. A GMS contract is one between GPs and NHS England and the practice where elements of the contract such as opening times are standardised.

The practice population is similar to the national average for younger people and children under four years of age, those of working age and those recently retired, and for older people aged over 65 years. Economic deprivation levels affecting children, older people are slightly higher than the practice average across England. Life expectancy for men and women is similar to national averages.

The practice patient list is higher than the national average for people who have long standing health conditions. It has a lower than the national average for working aged people in employment or full time education and higher numbers of working age people that are unemployed.

The practice is managed two GP partners who hold financial and managerial responsibility. The practice has one salaried GP, one locum GP and one GP registrar (Dr Kumar is a training practice and employs qualified doctors who are training to become GPs. These are called GP registrars). In total, two male and two female GPs work at the practice. The practice also employs four practice nurses. These nurses are shared with the second GP practice, separately registered with the care Quality Commission, which is located within the surgery premises. The clinical team are supported by a practice manager and a team of receptionists and administrators.

The practice is open from 8am and 6.30pm on weekdays. Appointments are available between 8.10am and 12.20pm; and between 3.30pm and 6pm. Late evening appointments are available up to 8.30pm two evenings each week. These are usually available on Monday and Tuesday evenings but may vary due to bank holidays or when the practice closes early for time to learn sessions. In these instances late evening appointments are available on Wednesday evenings. Any changes to the late opening times are advertised on the practice website and throughout the practice.

The practice has opted out of providing GP out of hour’s services. Unscheduled out-of-hours care is provided by IC24 and patients who contact the surgery outside of opening hours are provided with information on how to contact the service.

Updated 6 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kumar on 16 March 2016. Overall the practice is rated as good. The practice is rated as good for each of the domains and population groups.

Our key findings across all the areas we inspected were as follows:

• The practice ensured that when things went wrong that these were investigated and learning was shared with staff.
• Staff were trained and had access to procedures and information to help safeguard adults and children from risks of abuse and neglect.
• There were systems for assessing and managing risks to patients and staff. These included risks associated with fire, infection control, premises and equipment.
• Medicines were stored securely and checked regularly to ensure that they were in date. The practice had suitable equipment and a range of medicines to use in the event of a medical emergency. However GPs did not carry any emergency medicines when they carried out home visits.
• The arrangements for dealing with repeat prescriptions were not clearly defined and we saw that a small number of patients who were prescribed medicines such as warfarin without a record of the appropriate blood checks having been carried out and checked.
• There was a detailed business continuity plan to deal with untoward incidents that may affect the day to day running of the practice.
• Staff were recruited robustly with all of the appropriate checks carried out to determine each person’s suitability and fitness to work at the practice.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Data showed that the practice performance for monitoring and treating patients with long term conditions was similar to other GP practices.

• Information was shared with staff and other healthcare professionals appropriately to ensure a coordinated approach to patients care and treatment.

• There were procedures in place for obtaining patients consent to care and treatment and staff were aware of and followed these.

• Clinical audits and reviews were carried out to monitor and improve patient care and treatment.

• Staff were supported and received role specific training to meet the needs of patients and there was a system for staff appraisal.
• Patients said they were treated with dignity and respect and they were involved in their care and decisions about their treatment. They said that staff were helpful, polite and courteous. This was also supported by the results from the most recent GP patient survey.
• The practice sought to identify patients who were carers and to support them as appropriate.
• Information about services and how to complain was available and easy to understand. Complaints were investigated and responded to promptly and apologies given to patients when things went wrong or their experienced poor care or services.
• The practice offered a range of appointments including face to face, telephone and online consultations.
• Late evening appointments were available on two evenings each week.
• Some patients had reported delays in waiting to be seen and the practice had reviewed its appointments system to help address these issues.
• The practice was accessible to patients with mobility difficulties, had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The practice regularly monitored and reviewed the services offered and carried out a range of audits and reviews to improve the quality and safety of its services.
• Practice policies and procedures were appropriate and kept under review.
• The practice proactively sought feedback from staff and patients, which it acted on.

There were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Review the arrangements for managing repeat prescriptions to ensure that there is a consistent approach to reviewing them before these are issued.

• Review the arrangements for managing medical emergencies that may occur when GPs carry out home visits and have available medicines as deemed necessary.

• Review the arrangements for identifying patients who are carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 July 2016

The practice is rated as good for the care of people with long-term conditions.

• GPs and nursing staff had lead roles in chronic disease management and provided a range of clinics including asthma, diabetes and chronic obstructive pulmonary disease (COPD).

• The practice performance for the management of these long term conditions was similar to or higher than other GP practices nationally. For example;

• The percentage of patients with diabetes whose blood sugar levels were managed within acceptable limits was 74% compared to the national average of 77%

• The percentage of patients whose blood pressure was managed within acceptable limits was 82% compared to the national average of 83%.

• The percentage of patients with asthma who had a review within the previous 12 months was 73% compared to the national average of 75%.

• Patients at risk of unplanned hospital admission were identified as a priority and regular multi-disciplinary tem meetings were held to review and plan for any changing needs.

• Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 6 July 2016

The practice is rated as good for the care of families, children and young people.

• The practice offered same day appointments for children. Appointments were available outside of school hours.

• Post-natal and baby checks were available to monitor the development of babies and the health of new mothers.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.

• Immunisation rates were similar to other GP practices for all standard childhood immunisations. For example;

  The percentage of infant Meningitis C immunisation vaccinations and boosters given to under two year olds was 96% compared to the CCG percentage at 97%. The percentage of childhood Mumps Measles and Rubella vaccination (MMR) given to under two year olds was the same as the CCG percentage of 94%.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Information and a range of sexual health and family planning clinics were available.

Updated 6 July 2016

The practice is rated as good for the care of older people.

• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

• The practice offered proactive, personalised care to meet the needs of the older people. For example;

• The practice offered home visits and rapid access to telephone advice and appointments for those with enhanced needs.

• Weekly GP visits were carried out to a local care home to review patients and monitor changes to their healthcare needs.

• GPs worked with local multidisciplinary teams to reduce the number of unplanned hospital admissions for patients who were identified as being at increased risk including those with dementia and those receiving end of life palliative care.

Updated 6 July 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The appointment system was flexible and reviewed to meet the needs of patients. For example appointments were staggered following comments that some patients had to wait too long to be seen.

• Late evening appointments were available two evenings each week.

• Telephone consultations were available as required.

• The practice offered a full range of health promotion and screening that reflected the needs for this age group including NHS health checks.

Updated 6 July 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice reviewed and monitored patients with dementia and carried out face-to-face reviews.

• Patients with mental health conditions were reviewed and had an annual assessment of their physical health needs. For example;

  The percentage of patients with a mental health disorder, who had a comprehensive care plan in place was 98% compared to the national average of 88%.

  86% of patients with a mental health disorder had a record of their alcohol consumption compared to the national average of 89%.

• Longer appointments and home visits were provided as required.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• There was a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 6 July 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• Staff undertook safeguarding training and the practice had a dedicated safeguarding lead.

• The practice held a register of patients living in vulnerable circumstances including patients with a terminal illness and those with a learning disability.

• The practice proactively promoted annual health checks for patients with learning disabilities and nurses had received specific training to support these patients. Home visits were available for these reviews as needed.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. This helped to ensure that patients whose circumstances made them vulnerable were supported holistically and that patients who were at a higher risk of unplanned hospital admissions were supported to and treated in their home.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.